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General NPI Number Information
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NPI Number | 1497940019
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Entity Type | Organization
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Legal Business Name | LONG ISLAND VITREO RETINAL CONSULTANTS
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 47 COMMERCE DR SUITE 2
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City | RIVERHEAD
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State | NY
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Zip | 11901-3106
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Country | US
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Telephone | 631-905-0666
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Fax | 516-905-0660
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Provider Business Mailing Address
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Address Line | 47 COMMERCE DR SUITE 2
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City | RIVERHEAD
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State | NY
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Zip | 11901-3106
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Country | US
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Telephone | 631-905-0666
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Fax | 516-905-0660
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ANNMARIE GAMBA
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Credential |
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Telephone | 516-466-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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